Internal Application and Internal Skills Checklist

This Internal Application and Internal Skills Checklist is used by an employer and an

employee for the purpose of switching the employee to a different position within the

company. This document asks questions such as what experience or work history

qualifies the employee for the position, and what educational background that the

employee has that would qualify them for the position. This document in its draft form

contains standard clauses commonly used in these types of forms; however, additional

language may be added to allow for customization to ensure the specific language of

the user is addressed. This document can be used when a company is looking to hire

from within the company.

Internal Application and Internal Skills Checklist



Name

_________________________________ ___________________________

Last, First Social Security Number



_________________________________ ___________________________

Current Position/Title Current Department





I wish to apply for the position of ___________________________________________





Please describe your experience and/or work history that would qualify you for this position:



________________________________________________________________



________________________________________________________________



________________________________________________________________



________________________________________________________________





Describe your educational background that would qualify you for this position:



________________________________________________________________



________________________________________________________________



________________________________________________________________



Education and/or Skills Acquired Since Employed with us:



________________________________________________________________________



________________________________________________________________________



________________________________________________________________________



Note: A current resume should accompany this form. The skills checklist must be completed and

attached.



In signing below, I verify that the information presented in this application is accurate.



_________________________________ ___________________________

(Employee’s Signature) (Date)





Manager Approval

I verify this employee is currently NOT under disciplinary action, and has met the minimum (3 months

continuous employment) requirements for posting.



_________________________________ ___________________________

(Manager’s Signature) (Date)









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Skills Checklist



Use the following check list to identify experience and skills.

Blank spaces are provided for skills not listed.



 Accounting  Editor/Editing Experience

 CRT/Data Entry  Financial Aid Experience

 Cash Collections  Payroll

 Appointment Scheduling  AC & Heating (HVAC)

 Telephone Professionalism  Automotive Mechanic

 Financial Screening  Carpentry

 Medicare Updating  Animal Science/Care/Surgery

 Patient Arrival Coordinator  Cashier

 Patient Services Assistant  Dispatch

 Web Development  Drafting/CAD

 Coding  Chemistry

 Insurance  Truck Driving (Heavy)

 Medical Transcription  Truck Driving (Light

 Mail Distribution  Electrician

 Manuscript Typing  Garden/Grounds keeping

 Medical terminology  Indus/Hotel Housekeeping

 Billing  Law Enforcement

 Receptionist  Locksmith

 Switchboard  Machine/Machine Shop Exp

 Windows 2000  Maintenance (gen building)

 CMT Cert Medical Tech  Painting

 MS Office 2000  Plumbing

 CPA Cert Public Acct  Print Shop Experience

 Assembly  Welding

 MS Project 2000  Computerized Tomography

 COBOL  Cytology/Cytopathology

 PERL  Echocardiograph (Ultra)

 JCAHO  Electro-cardiograph (EKO)

 Focus  EEG Technology

 Fortran  Magnetic Resonance Exp

 Harvard Graphics  Medical Technology

 Adobe Acrobat  Nuclear Medicine Exp

 LAN Network  Radiation Therapy

 Microsoft Word  Radiology (X-RAY)

 Personal Computer  Mammography

 Novell  Architecture

 Oracle  Art/Graphics/ Photography

 WordPerfect  Attorney/Lawyer

 UNIX  Auditing

 MS PowerPoint  Bid Analysis/Preparation

 MS Project  Budget Preparation

 MS Publisher  Research

 Data & Word Processing 

 Nursing Care Experience 

 Claim Analysis 

 Cost Forecasting/Analysis 

 Quality Assurance 

 Collections 









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INFORMATION AND FORM